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  • Treating male retention patients with temporary prostatic stent in a large urology group practice

    Roach M. Richard, MD Advanced Urology Institute, Oxford, Florida, USA

    Men with either chronic or temporary urinary retention symptoms are common patients treated in a urology practice. Both indwelling and intermittent catheterization are widely used to treat this condition. These approaches are associated with significant complications including infection and reduced quality-of-life. Infection is a target for quality improvement and cost reduction strategies in most care settings today. We use a temporary prostatic stent (TPS) to address these issues in our practice. In this report, we describe our approach to patient selection, sizing, placement and follow up of 214 TPS placed in 56 men with chronic or temporary urinary retention in an office setting. With the first stent placement, average indwelling time was 27 days. Thirty-two patients had multiple stents placed. Replacement was performed routinely and was generally required because underlying comorbidities precluded surgery. In these patients, an average of six stents were placed (range 2-18) with average dwell times of 31 days. Symptomatic urinary tract infections (SUTI) occurred in only 6 of 214 TPS placements (2.8%), resulting in an incident rate of 0.93 SUTI per 1,000 TPS days. TPS is a safe and efficacious means of alleviating symptoms of urinary retention. TPS does not share the same infection risk profile or quality-of-life drawbacks associated with urinary catheters; this makes TPS use relevant as a urinary catheter alternative or when a urinary catheter is not recommended.

    Keywords: benign prostatic hyperplasia, LUTS, urinary retention, lower urinary tract symptoms, temporary prostatic stent,

    Apr 2017 (Vol. 24, Issue 2, Page 8776)
  • How I do it: Aquablation of the prostate using the AQUABEAM system

    MacRae Catriona, Gilling Peter, MD Department of Urology, Tauranga Hospital, Tauranga, New Zealand

    Benign prostatic hyperplasia (BPH) represents one of the most common conditions encountered in urological practice. For many years, transurethral resection of the prostate (TURP) has been considered the gold standard for surgical management of symptoms in prostates of 30 cc-80 cc. Although TURP provides excellent functional outcomes, there is significant morbidity associated with the procedure, particularly with regards to bleeding, electrolyte imbalance and sexual dysfunction. Emerging technologies aim to maintain the excellent functional results of TURP whilst decreasing the adverse events experienced by the patient. Aquablation is a novel therapy using a high-velocity waterjet and real-time ultrasound imaging with robotic assistance for targeted removal of prostate tissue. We present our experiences with this new technique, the equipment required and steps involved.

    Keywords: benign prostatic hyperplasia, transurethral resection of prostate, ablation techniques, aquablation, bladder outlet obstruction,

    Dec 2016 (Vol. 23, Issue 6, Page 8590)
  • How I do it: Same day discharge for transurethral resection of prostate using Olympus PlasmaButton and PlasmaLoop

    Pham Ryan, Parke Jacob, Kernen M. Kenneth, MD Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, USA

    Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting older men. Transurethral resection of the prostate (TURP) has widely been considered the gold standard in surgical treatment for BPH. However, this procedure remains largely an inpatient procedure. Inpatient admission ultimately adds to healthcare cost and patient morbidity. In this article, we present an alternative methodology to treat BPH using combination Olympus PlasmaButton and Olympus PlasmaLoop therapy. Preliminary results from our experience suggest improved hemostasis with adequate resection, allowing a majority of our patients to be discharged the same day of the procedure. We describe our novel technique as a safe and effective way to possibly treat BPH in an outpatient setting.

    Keywords: benign prostatic hyperplasia, transurethral resection of prostate, monopolar- transurethral resection of prostate, bipolar- transurethral resection of prostate, continuous bladder irrigation, transurethral vaporization of prostate,

    Oct 2016 (Vol. 23, Issue 5, Page 8491)
  • Initial North American experience with the use of the Olympus Button Electrode for vaporization of bladder tumors

    Canter J. Daniel , Ogan Kenneth, Master A. Viraj, MD Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA

    The current treatment standard of care for patients who present de novo or with a recurrent bladder tumor is transurethral resection of the bladder tumor (TURBT) using monopolar or bipolar electrocautery in the form of a 90-degree loop electrode, which has been used since its introduction in 1952. This intervention, accomplished transurethrally, is both diagnostic and potentially therapeutic for patients with bladder cancer, especially for low grade, non muscle-invasive bladder tumors. Although usually safe and sufficient, this technique can create technical challenges, especially in the dynamically changing spherical space of the bladder. Bipolar energy has been available for many years and has been readily adopted for the endoscopic treatment of benign prostatic enlargement. A further refinement on bipolar energy has been the recent introduction of the Olympus Button Electrode (Olympus, Southborough, MA, USA). Coupling bipolar energy into the Olympus Button Electrode not only harnesses the benefits of less thermal spread but also obviates many of the geometric challenges associated with loop electrodes during resection of either large or inauspiciously placed bladder tumors. In this article, we detail our initial experience vaporizing bladder tumors with the Olympus Button Electrode. Although still very early in our experience, we have been able to completely vaporize very large tumors as well as tumors located in difficult parts of the bladder to access with minimal blood loss and no bladder perforations. Furthermore, our ability to obtain adequate grade and stage information has not been compromised by using this vaporization technique.

    Keywords: bipolar electrocautery, prostatic urethral lift, UroLift, benign prostatic hyperplasia,

    Apr 2012 (Vol. 19, Issue 2, Page 6211)
  • Olympus PlasmaButton transurethral vaporization technique for benign prostatic hyperplasia

    McClelland Michael, MD Urology Austin, Austin, Texas, USA

    OBJECTIVE: This article will describe an efficient and effective method of using Olympus PlasmaButton (Olympus, Southborough, MA, USA) for transurethral vaporizations of the prostate (TUVP). METHODS: This method was developed over the last 18 months. Patients undergoing this Olympus PlasmaButton TUVP had the inner aspect of the prostate vaporized until it was believed to be significantly open and unobstructed. RESULTS: Patients were found to do very well with what appears to be durable results. Postoperative short and long term bleeding has not been a significant issue using this method. CONCLUSION: The Olympus PlasmaButton procedure is a new minimally invasive therapy for benign prostatic hyperplasia (BPH). As with all new technologies there are methods that a surgeon learns with increased experience that help make the procedure more effective, efficient, and safer. This article shows one surgeon’s technique that has been developed over time and has become a successful way to manage patients undergoing the minimally invasive transurethral vaporization of the prostate. There are probably other vaporization techniques that surgeons have learned with use of the PlasmaButton that may be equally effective.

    Keywords: benign prostatic hyperplasia, photovaporization, transurethral vaporization of the prostate, technique,

    Apr 2011 (Vol. 18, Issue 2, Page 5630)
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Apr 2017, Vol.24 No.2
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